·论著·作者单位:100083北京大学眼视光学研究中心通讯作者:谢培英,Email:xpy@b2d1ac1cn圆锥角膜的角膜地形图分析姜宏钧谢培英【摘要】目的探讨圆锥角膜的屈光状态和角膜地形图形态分布。方法147例(262只眼)圆锥角膜,使用电脑验光和角膜曲率仪与计算机辅助的角膜地形图仪测量眼部屈光度、角膜曲率、角膜散光度、角膜表面规则指数(SRI)、表面非对称指数(SAI)及进行角膜形态学描述。结果将圆锥角膜患者分为可疑、轻度、中度及重度。病灶形态分为蝶形和非蝶形。蝶形又分为对称和不对称;非蝶形又分为乳头状、卵圆形、球形及不规则形。蝶形病变,以对称蝶形多见,常见于可疑和轻度病例。乳头状和卵圆形,多见于轻、中度病例,多位于角膜中央或中央偏下方;球形多见于中、重度病例,多位于角膜中央;不规则形见于重度病例。多数患者双眼病灶间存在对称性。病变直径与角膜顶点屈光度间无相关性(r=01208,P=01092),病变顶点距中心距离与顶点屈光度间呈负相关(r=-01400,P=01001)。结论利用角膜地形图,可筛查和早期诊断圆锥角膜,有助于采取及时适当的治疗,避免对圆锥角膜患者进行准分子激光角膜屈光手术;同时了解病变在角膜上的分布规律,可指导硬性角膜接触镜的验配。(中华眼科杂志,2006,42:2312235)【关键词】角膜地形图;圆锥角膜;接触镜;屈光,眼TheanalysisofcornealtopographyforkeratoconusJIANGHong2jun,XIEPei2ying.PekingUniversityOptometry&OphthalmologyCenter,Beijing100083,ChinaCorrespondingauthor:XIEPei2ying,Email:xpy@b2d1ac1cn【Abstract】ObjectiveToinvestigatetherefractionandvideokeratographiccharacteristicsofkeratoconus1Methods262eyesof147patientswithkeratoconuswereexaminedusingautorefractorandcomputerizedcornealtopography,whichgeneratedthequantitativedescriptorsincludingrefraction,keratometry,cornealastigmatism,thesurfaceregularityindex(SRI),thesurfaceasymmetryindex(SAI),andmorphologicdescription1ResultsAllpatientswereclassifiedintofourgroups:suspect,mild,moderateandadvancedgroup1Thetopographicalconfigurationsofthelesionsweredividedintobow2tiepatternsubdividedintosymmetricandasymmetricpattern,andnon2bow2tiepatternincludingnipple,oval,globalandanomalisticpattern1Thebow2tiepatternmostlyappearedsymmetricalandoccurredinsuspectandmildcases1Thenippleandovalpatternmostlyoccurredinmildandmoderateoneslocatedinthecentralorinferiorparacentralcornea1Theglobalpatternmostlyoccurredinmoderateandadvancedoneslocatedinthecentralcornea1Theanomalisticpatternoccurredinadvancedones1Bilateraltopographyshowedsymmetricalinmajorityofpatientswithbilateralkeratoconus1Therewasnocorrelationbetweenthediameteroflesionandtherefractionpowerofcornealapex(r=01208,P=01092)1Therewasnegativecorrelationbetweenthedistancefromcornealcentertotheapexoflesionandtherefractionpowerofcornealapex(r=-01400,P=01001)1ConclusionsCornealtopographyisasensitivemethodtodetectthekeratoconusearlier,whichhelpseyedoctorstotakeappropriatemeasurestoimprovepatientsvisionandavoidpatientsfromundergoingexcimerlaserkeratorefractivesurgery1Inaddition,itcanshowtheconfigurationofthelesion,whichguidethefittingofhardcontactlens1(ChinJOphthalmol,2006,42:2312235)【Keywords】Cornealtopography;Keratoconus;Contactlenses;Refraction,ocular圆锥角膜是一种双侧非炎性角膜扩张性疾病,但是也可单侧眼先发。其特征主要为中央和旁中央区角膜基质变薄和呈圆锥形突起。通常开始于青春期,有一定自限性,可终止于任何年龄,一般多于30～40岁时停止发展。发病早期主要表现为近视和散光的持续增长,可用框架眼镜和软性角膜接触镜进行视力矫正。如果早期给予硬性透气性角膜接触镜(rigidgaspermeablecontactlens,RGPCL)治疗,可以获得良好的视力效果并控制疾病进展。所以圆锥角膜的早期诊断尤为重要。目前,计算机辅助...
